Provider Demographics
NPI:1619799384
Name:TEDESCHI, EMILY PELHAM (MSED)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:PELHAM
Last Name:TEDESCHI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6245
Mailing Address - Country:US
Mailing Address - Phone:718-869-9787
Mailing Address - Fax:
Practice Address - Street 1:91 LAKES RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2613
Practice Address - Country:US
Practice Address - Phone:718-869-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool